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Aetna Medicare Premier (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Premier (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Premier (PPO) in 2025, please refer to our full plan details page.
Aetna Medicare Premier (PPO) is a PPO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in WI Southeast. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Premier (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Premier (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Premier (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $16.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for Aetna Medicare Premier (PPO)
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Drug Coverage
The Aetna Medicare Premier (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $16.
Additional Benefits
The Aetna Medicare Premier (PPO) plan offers comprehensive coverage with a variety of benefits. This plan covers inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with copays. Preventive services, hearing, vision, and dental services are included, with benefits like no copays for many preventive services, hearing exams, and eyewear. Additionally, the plan provides coverage for home health services, skilled nursing facilities, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the Aetna Medicare Premier (PPO) plan. For Inpatient Hospital-Acute, you will pay a $265 copay for days 1-8 and no copay for days 9-90, while for Inpatient Hospital Psychiatric, you will also pay a $265 copay for days 1-8 and no copay for days 9-90.
Outpatient Services See details
Outpatient services are covered by the Aetna Medicare Premier (PPO) plan, including outpatient hospital services with a copay of $0-$265, observation services with a $265 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $75 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Aetna Medicare Premier (PPO) plan, with a $75 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Aetna Medicare Premier (PPO) plan, with a $280 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Premier (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay, while Worldwide Emergency Transportation has a $280 copay.
Primary Care See details
The Aetna Medicare Premier (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, and physician specialist services have a copay between $0 and $30. Mental health and psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $75. Opioid treatment program services have a $40 copay, while podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered zero dollar preventive services, annual physical exams with no copay, and additional preventive services including Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Wigs for Hair Loss Related to Chemotherapy, all with no copay. Kidney Disease Education Services have a 20% coinsurance, while services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, and Telemonitoring Services are not covered. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $750 per year, and all types of prescription hearing aids are covered. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Aetna Medicare Premier (PPO) plan covers vision services, including eye exams with a copay between $0 and $30, and routine eye exams and other eye exam services with no copay. Eyewear is covered with no copay, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 every year.
Dental Services See details
The Aetna Medicare Premier (PPO) plan covers Medicare Dental Services with a $30 copay, and other dental services with a $1,750 maximum benefit per year. Oral exams, dental x-rays, other diagnostic and preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Aetna Medicare Premier (PPO) plan, including Durable Medical Equipment (DME) with no copay and a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies. Diabetic Equipment is covered, with a coinsurance between 0% and 20% for Diabetic Supplies and no copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $195, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Aetna Medicare Premier (PPO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (PPO) plan. The plan does not cover cardiac rehabilitation services, intensive cardiac rehabilitation services, pulmonary rehabilitation services, or SET for PAD services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
Under "Other Services", the Aetna Medicare Premier (PPO) plan does not cover acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, Self-Directed Personal Assistance Services. Over-the-counter (OTC) items and meal benefits are covered with no copay, and the plan provides up to $60 every three months for OTC items. Other services, including annual wellness exams and screening mammography, and gFOBT, FIT, are covered with no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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